Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Friday, February 15, 2008

I have no ties with this company, in fact, I found it when I clicked the ad on MDOD. There's no reason you can't do this yourself and I didn't read the fine print but this service might be worth it for other reasons. If you bring one of these to your next ER visit the doctors and nurses will think you are a genius.

* THE MANUFACTURER WAS PLEASED WE HAD SENT SOME OF OUR READERS TO THE 'MEDCARD' SITE. THEY ARE OFFERING THE FOLLOWING DISCOUNT FOR OUR READERS...911doc, to encourage your bloggers to join, I have created a Partner Code: “MDOD”, which, when used during registration, will save $20 on all 3 membership plans. The credit will appear before the order is submitted for payment.Mike Stephens, CEOMY MEDCARD, INC.

anna, i'm not sure what you are talking about... i'm sure there are lots of similar products BUT any care you have recieved at other hospitals, unless you have it on a card or in some other form of history, is not easily accessed by the ER when you arrive.

I have a card I printed out from here for free in my wallet http://www.medids.com/free-id.php, an interactive road id from roadid.com on my ankle, and the card that came with my insulin pump in my wallet, so I think I'm covered.

1) Have your form of payment out. Debt, cash, whatever.2) Have a rough estimate of how much your order will cost; that means that if you do not have enough money to pay for it, don't be a douchebag.3) Don't make me void off your entire purchase. Or, all the toys that you just bought for your spawnx10; I don't like it when kiddos cry.4) If you are paying with food stamps, you really have no room to be a douchebag to me.5) This includes: bitching about the price of your Hawaiian punch; the ten cent difference in your loaf o' white-bread.6) It's .10 per pound, not .10 for the entire bunch. Also, please learn to speak English.7) Yes, I am sick. And I am coughing all over your bananas. The only reason that you get LOW LOW PRICES is because I am not paid a living wage nor given sick leave; five absences in a six-month period and I am fired. Suck it up, bitch.8) WIC no longer takes Juicy Juice. No Juicy Juice for you!9) I only judge you because you are riding on a motorized scooter, weigh 400+ pounds, and have bought an entire basket worth of candy bars. Yes, you are fat.10) If you can afford $200 worth of cosmetics and hair products, you can probably afford the $50 worth of food that you buy to feed your children. On foodstamps.

Information on a card that would actually be read? That is a new and refreshing concept.It is somewhat annoying that, when you are truly sick and all you want is something that makes you feel better, you are asked 2 or 3 times the same questions by scrub-wearing personnnel, one of which could be the janitor, for all you know.And here comes the doctor. This is my favorite part: same questions AGAIN! (because he did not have time to read your chart). OK, no problem, I will gladly repeat myself but the question that comes to mind is: why purpose did the other 2 or 3 serve?

One purpose is that patients either forget their meds and or allergies or give 3 different answers which requires clarification, either because they are sick, stupid, demented, or obfuscating the fact that they already got Lortab 2 days ago. If I only read a chart that is incorrect and give you a medication that kills you, I spend 6 months in depositions, time away from my family, all because you were irritated you had you repeat yourself.

I took an elderly lady to ER because she had fallen and her arm was hurting. (It turned out later it was broken).I stayed with her all the time so I saw her answer twice to two different people how she had fallen, what caused the fall and how/where she hurt.In comes the doctor with the question:"You arm hurts? How is it hurting?"The elderly lady answers - once again - where and how it hurts. The doctor looks at her with a smile and says, as if she were insane: "And why does it hurt that way?"I could see real exasperation on this lady's face when she looked back at him from over her glasses and said: "Because... I fell on it???".The doctor answered: "oh,hmmm.. well.. I did not have time to read your chart."

My question is still: why bother answering the other two that came before the doctor?

Amy, you are correct that the patient gets asked the same questions multiple times.

The triage RN needs to know how sick you are, the RN who assumes your care in the ED needs their own JCAHCO required assessment, the registration/insurance people need to know some details of your illness or accident in order to file your claim correctly, and I'm not taking anyone else's word about your history since I'm responsible for it.

You recite one example of how a story didn't change. I can site 3 from today alone of how significant historical details DID change. The fact that the story changes is often quite significant in itself.

One patient today had been asked by 2 or 3 different people before me about allergies. She admitted to none. When I asked, she suddenly "remembered" IV contrast dye (which was relevant since I was ordering a contrast enhanced CT scan).

I frequently re-ask questions that I have read on the RN notes (as if I don't know). I want to see if I'm given the same answer...or if my perception of the answer is the same. This doesn't mean I haven't read the chart because 90% of the time, I have.

Well, and sometimes as a patient, you honestly don't know what's relevant and what's not. I know that relaying any allergies and what meds you're taking is important, but if I'm in the ER for a fall, does the triage nurse/doctor really care that I have PCOS or migraines(which counts as a "medical condition", I guess.)?

As a patient who's been asked questions before - after having answered them before - it's a little funny for us. After filling out all the paperwork, and documenting my prior surgeries and then giving birth, my OB/GYN still felt around for my gall bladder, "does this hurt?", "about here?" I finally said: "If you're looking for my gall bladder I don't have one. That's why that scar is there." Obviously he's not a gastro. guy, and he's very busy, but it was still funny and I enjoyed laughing at him a little.

Half the people who give me a list of meds or whatever have had the dosages changed or the meds discontinued when I ask about each individually. A fancy card is only good if you plan on being the same for the rest of your life. Otherwise, update your lists, dangit.

Long ago I typed up a piece of paper with the answers to all the questions that I had to answer every time my husband goes to ER. Now I can hand a piece of paper to triage and they have his medical and surgical histry, current meds, drug allergies (including his reaction to it), a list of recent hospitalizations, and who his PCP is. Since everybody wants to keep a copy I take at least 3. The great thing is that because it's on my computer it's easy to update with every change.

I like the patients who think their generic version is the real thing.."Don't be tryin to pass off that Lasix crap, I want FUROSEMIDE!!". I'm convinced Micardis is failing because of its name. It might be a very effective antihypertensive, but the name reminds me of myocarditis and lawsuits.

I think every decade has its fad illness, in the 80's it was "hypoglycemia". Chronic fatigue/fibromyalgia/gulf war syndrome in the 90's. With the 00's 80% over, I'm not sure what this decades is..maybe Adult ADD? I'll never forget the Navy guy who wanted a referral to participate in a study for Gulf War syndrome. He had never left Jacksonville Florida!! He thought he might have caught it from a ship, except he didn't work on a ship, but people from the gulf did occasionally come home and he might have bumped into one of them and been infected with whatever agent causes the disease.